title: National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA.
abstract: OBJECTIVE
  While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national trends after major cancer surgery.
  
  
  METHODS
  Retrospective, cross-sectional analysis of a weighted-national estimate from the Nationwide Inpatient Sample (NIS) undergoing major oncological procedures (colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy and prostatectomy). The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were utilised to identify trends in hospital-acquired adverse events.
  
  
  METHODS
  Secondary and tertiary care, US hospitals in NIS PARTICIPANTS: A weighted-national estimate of 2 508 917 patients (>18 years, 1999-2009) from NIS.
  
  
  METHODS
  Hospital-acquired adverse events.
  
  
  RESULTS
  324 852 patients experienced ≥1-PSI event (12.9%). Patients with ≥1-PSI experienced higher rates of in-hospital mortality (OR 19.38, 95% CI 18.44 to 20.37), prolonged length of stay (OR 4.43, 95% CI 4.31 to 4.54) and excessive hospital-charges (OR 5.21, 95% CI 5.10 to 5.32). Patients treated at lower volume hospitals experienced both higher PSI events and failure-to-rescue rates. While a steady increase in the frequency of PSI events after major cancer surgery has occurred over the last 10 years (estimated annual % change (EAPC): 3.5%, p<0.001), a concomitant decrease in failure-to-rescue rates (EAPC -3.01%) and overall mortality (EAPC -2.30%) was noted (all p<0.001).
  
  
  CONCLUSIONS
  Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.
authors.affiliation: Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Mai-Kim
authors.initials: MK
authors.lastname: Gervais
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
keywords: Cancer surgery; Patient Safety Indicators; Preventable Adverse Events; Quality Improvement